Goals and Objectives:

1. Exposure to a broad spectrum of neurological pathology in all work shifts, with a variable range of presentations.  

2. Perform the initial assessment of the patient and actively participate in all aspects of patient care, including history and physical, diagnostic and therapeutic planning, procedures, and writing orders.

3. Mastery on identifying and managing most of the common neurological presentations, especially acute, and life-threatening pathology.

4. In-depth discussion of all cases with the attending physician or senior resident before initiation of diagnostic studies, management or therapeutic interventions. 

5. Junior neurology resident should represent as a leader and teacher for the rotating residents and medical students on service, providing supervision and support as needed.

6. Participating in research opportunities alongside their attending and senior resident physicians.

7. Should have a flavor for all the branches of neurology in both inpatient and outpatient settings, to allow interest to evolve and help guide future planning.

8. All procedures must be performed with complete approval and supervision of attending or senior resident.

9. Junior residents are responsible for maintaining medical records.

Structure:

There is one junior resident at Tufts responsible for the inpatient Neurology service. The team also consists of the consult and senior residents, as well as the neuro-critical care (NCCU) resident, a night float resident, and other rotating physicians or physicians in training including medical students, psychiatry residents, and medicine residents.

There is a neurology ward attending (who handles the inpatient service, consults, and stroke codes) as well as a stroke attending (only does inpatient stroke consults and stroke codes in the morning). Consults during the day are staffed with the attending until they leave for the day (sometime in the late afternoon), otherwise consults are staffed with the senior. Stroke codes are always staffed with the ward attending unless there is a stroke fellow, who will sometimes take call. 

Hours: 7am sharp (try to be a little early) to 5 some days (short call) or 7 other days (long call). The short/long call system includes the consult resident, so you'll need to work out at the beginning of the week who will be doing which days. 

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Responsibilities:

- Arrive no later than 7:00 am for sign out from night float. Sign out new patients and overnight events from 7:00 - 7:30 am.

- Switching the pagers at the time of sign out (pager number 2038)

- Pre-rounding is not required, but for critical/clinically unstable patients should be seen before rounds. If the patient requires a different level of care, the appropriate communication should be initiated with the senior resident.

- Rounds start at 8:00 am with the team, including senior resident, junior resident, attending, and medical student. The junior resident is expected to well-versed with the cases, history, pertinent examination findings, and updates. Optimally the junior resident should be rounding with a working station (WOW), and updating the progress note, putting orders, sending important pages. 

- CAP rounds from 9:15–9:30 am, run by the senior. It is preferred for junior residents to join the rounds unless they have essential/urgent responsibilities.

- Running the list after rounds: it is a chance for the team of a senior and a junior to meet and discuss the plans, update the to-do list, and split work based each resident’s roles.

- Junior residents are responsible for making all the necessary care for the patients on the service up until the time they sign out their pagers and leave the hospital.

- Direct admission to the floor: Junior resident is in-charged of making direct admission to the service, whether the patient is accepted from another facility, or the clinic. The consult resident is responsible for covering ED admissions. The junior resident should always make sure to get a full sing out for patients admitted by the neurology consult team/resident before the patient arrival to the ward, and to asses the patient soon after the having the handoff.

- Accepted transfers to the floor from other services have to be seen at the time of acceptance, a detailed handoff and a transfer document/discharge summary must be received from the transferring service. Juniors then will examine and assess the patient and make sure that an acceptance note is in the system.

- It is always a point of strength to understand one’s limitations. Understand our limitations and knowing when to escalate, and when to ask for help is a key part in the team dynamics.

- We have always to remember that our priority #1 is quality patient care.

- As a part of the team, juniors play a fundamental role in maintaining harmony and collegiality inside our team.

Short call:

Signing out the inpatient service to the consult resident at 5 pm. By the time of singing out, it is expected that progress notes are up-to-date and signed, required orders are made, and communications with other teams and family were covered.

- Long call: Long calls are alternating between the junior resident and the consult resident. If one or the other is doing more than two consecutive weeks, the number long call is evened out over the two weeks period.

- 5:00 pm junior resident should be ready to get the sign out from the consult residents.

- 5:00 pm to 7:00 pm the long call resident is covering the inpatient neurology service, the consult service, new consults and stroke codes. Resident’s pager must cover the junior neurology and the consult neurology pager.